Reading of the Week: Mental Illness and Bay St., and More

From the Editor

Recently, I spoke with a woman I hadn’t met before – a friend of a friend, gathered over coffee by a kitchen table. When she found out that I was a psychiatrist, she talked about her daughter’s struggle with mental illness and I thought how rarely people spoke to me about such things just a decade ago.

As people grow more comfortable talking about their experiences and their family’s experiences with mental illness and as stigma slowly fades, these conversations on Main Street, so to speak – at our kitchen tables and at our kids’ baseball games – are growing more and more common. But people in the corporate world are also growing more aware of the need for us to address mental health problems. No wonder. Consider that the single biggest reason for people to be on disability in Canada is mental illness. And so, there are conversations on Bay Street, too.

In this week’s Reading, we consider a new essay from the Harvard Business Review. In it, CEO Kelsey Meyer talks about her company’s development of a mental health policy.

Also in the Reading: journalist Scott Stossel reviews Dr. Peter Kramer new book on antidepressants – and his own experience with medications.

Please note that the Readings will be “going fishing” for the next two weeks, returning on 11 August.

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 2 of 2

From the Editor

Is an ounce of prevention worth a pound of cure? As noted last week, psychiatry tends to emphasize the treatment of illness, not its prevention. But preventing illness is our ultimate goal.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Last week. The psychosis risk calculator.

This week. Cost-effective prevention.

In this week’s Reading, we look at a paper that considers CBT to prevent psychosis in an ultra high-risk group; the paper also considers the cost-effectiveness of the intervention. So is Ben Franklin right in arguing that an ounce of prevention is worth a pound of cure? The paper doesn’t weigh in on Franklin, of course, but it does find that CBT is economically sound with an 83% likelihood of reducing the transition to psychosis and at a lower cost.

DG Continue reading

Reading of the Week: Can We Prevent Psychosis? Part 1 of 2

From the Editor

Here’s a quick statistical summary of the Readings for the past 12 months.

Total: 48.

Number discussing the prevention of mental illness: One.

Is an ounce of prevention really worth a pound of cure?

Like all of medicine, psychiatry tends to emphasize the treatment of illness, not its prevention. This isn’t the result of a vast medical-industrial conspiracy, of course, but the reality that our field is young and the causes of mental illness aren’t well understood.

But preventing illness is our ultimate goal. Consider the suffering and cost that could be avoided if a person at risk of psychosis didn’t convert, as an example.

Can we prevent psychotic illness?

Prevention is built on two things: we need to identify at risk individuals, and then we need to use appropriate measures to prevent the illness.

Over the next two weeks, we look at a few papers that seek to identify at risk individuals and prevent psychosis in them.

This week. The psychosis risk calculator.

Next week. Cost-effective prevention.

In this week’s paper from The American Journal of Psychiatry, Cannon et al. develop a risk calculator to predict psychotic disorder. The tool they develop has an accuracy rate of 71% – comparable to calculators used for determining cancer recurrence.

DG Continue reading

Reading of the Week: Do the Meds Work? Peter Kramer’s Essay, and More

From the Editor

Do the pills really work?

It’s a question that we clinicians are repeatedly asked. Antidepressants are widely prescribed, but often doubted – by our patients and by people in general.

This week, we look at an essay penned by Dr. Peter Kramer, an American psychiatrist. Dr. Kramer, you may recall, made a name for himself two decades ago by extolling the super-therapeutic powers of Prozac. Today, he has a more modest goal: explaining the role of antidepressants in the treatment of depression.

Then, looking to The New England Journal of Medicine, we consider a paper that discusses the rise and, perhaps, fall of randomized controlled trials as the “gold standard” of medical research.

DG Continue reading

Reading of the Week: C-14 and Medically Assisted Dying

From the Editor

Over the years, Readings have considered big papers and big essays. This week’s Reading considers big legislation.

Last Friday, C-14 was given Royal Assent, having finally achieved Senate approval, thereby becoming law.

The Parliament of Canada

“An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying)” is unlikely to be the end of this debate. Indeed, it is likely to be part of the beginning of a larger societal debate on death and medicine.

In this Reading, we look at C-14 and, as well, an essay by Dr. Sonu Gaind on mental illness and physician-assisted death.

DG Continue reading

Reading of the Week: I Can’t Sleep – Insomnia, Part II of II

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

Last week. Fewer Pills, More Therapy. The new Clinical Practice Guidelines.

This week. Insomnia, Is There an App for That? The GoodNight Study.

This week, turning to a new paper from The Lancet Psychiatry, we consider an online insomnia program to prevent depression relapse.

DG Continue reading

Reading of the Week: I Can’t Sleep – Insomnia, Part I of II

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

This week. Fewer Pills, More Therapy. The new Clinical Practice Guideline.

Next week. Insomnia, Is There an App for That? The GoodNight Study.

This week, we look at the new American College of Physicians Clinical Practice Guideline on insomnia that suggests that CBT-Insomnia should be the first-line treatment.

DG Continue reading

Reading of the Week: Cost and Mental Illness

From the Editor

When we think about mental illness, we often think about loss – loss of friendships, loss of opportunities, and, in some cases, loss of life.

From a societal perspective, mental illness is often accompanied by another loss: economic.

Here are two papers that consider the long economic shadow cast by mental illness.

In the first, the authors consider mental illness and high-use consumers of health care. Specifically, the paper asks a simple if important question: looking at people who heavily use the health-care system, what percentage have mental health and addiction problems? The second paper, which draws on US data, calculates the cost of treating mental health disorders compared to other disorders.

DG Continue reading

Reading of the Week: Guest Contribution – Dr. David Goldbloom on Lithium and Self Harm

From a Contributing Editor, Colleague and Friend of the Editor

Sixty-seven years ago, Australian psychiatrist John Cade published his case series on manic patients treated with lithium – truly the dawn of the modern era in psychopharmacology. Two decades passed before lithium came to Canada, and almost three before it came to the United States. In the treatment of mania, it was the first significant drug alternative to the only other enduring treatment from that time – electroconvulsive therapy.

Dr. John Cade (and Lithium)

Today, however, lithium suffers from under-promotion (there is no money to be made on it by the pharmaceutical industry) and under-exposure in the training of residents despite the evidence of its benefit that continues to emerge.

Here is a new paper that looks at suicide and self-harm during maintenance treatment of people with bipolar disorder treated with lithium, valproate or the increasingly popular second-generation antipsychotic drugs. And here is an old paper that reminds us what a difference lithium had already made in the economics of mental illness by 1980.

– David Goldbloom, OC, MD, FRCP(C) Continue reading

Reading of the Week: Cancer and Mental Illness

From the Editor

“Now that I’m done with my [cancer] treatment, I’m struggling to figure out who I am,” writes essayist Suleika Jaouad.

This week’s Reading focuses on cancer and mental illness.

We open with a major new paper just published by JAMA Oncology (involving hundreds of thousands of cancer patients) and we then consider an essay by Suleika Jaouad talking about how cancer affected her physical and mental health.

DG Continue reading